Provider Demographics
NPI:1942223102
Name:KERLAN, DANIEL L (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:KERLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SPRING STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2870
Mailing Address - Country:US
Mailing Address - Phone:404-389-1950
Mailing Address - Fax:678-444-4152
Practice Address - Street 1:2230 TOWNE LAKE PARKWAY
Practice Address - Street 2:BLDG 1300, STE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:678-445-5444
Practice Address - Fax:678-445-5552
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110764003FMedicaid